Fri Nov 11 2022

77 articles - From Friday Nov 04 2022 to Friday Nov 11 2022

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Guidelines

Guidelines and related publications, position statements, white papers, technical reviews, consensus statements, etc…


Meta-analysis

meta-analyses and systematic reviews

Lancet

Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials.

Interpretation In addition to the established cardiovascular benefits of SGLT2 inhibitors, the randomised data support their use for modifying risk of kidney disease progression and acute kidney injury, not only in patients with type 2 diabetes at high cardiovascular risk, but also in patients with chronic kidney disease or heart failure irrespective of diabetes status, primary kidney disease, or kidney function. Funding UK Medical Research Council and Kidney Research UK.

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Original articles

RCT, clinical trials, retrospective studies, etc…

Ann Intern Med

Contact Tracing and Exposure Investigation in Response to the First Case of Monkeypox Virus Infection in the United States During the 2022 Global Monkeypox Outbreak.

In a contact tracing investigation involving 166 community and health care contacts of a patient with monkeypox, no secondary cases were identified. Primary funding source None.

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Oral ENT-01 Targets Enteric Neurons to Treat Constipation in Parkinson Disease : A Randomized Controlled Trial.

ENT-01 was safe and significantly improved constipation. Primary funding source Enterin, Inc.

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Perioperative Safety and Early Patient and Device Outcomes Among Subcutaneous Versus Transvenous Implantable Cardioverter Defibrillator Implantations : A Randomized, Multicenter Trial.

The S-ICD reduces perioperative, lead-related complications without significantly compromising the effectiveness of ICD shocks, but with more early postoperative pain and a trend for more inappropriate shocks. Primary funding source Boston Scientific.

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Lancet

Bivalirudin plus a high-dose infusion versus heparin monotherapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a randomised trial.

Interpretation In patients with STEMI undergoing primary PCI predominantly with radial artery access, anticoagulation with bivalirudin plus a post-PCI high-dose infusion for 2-4 h significantly reduced the 30-day composite rate of all-cause mortality or BARC types 3-5 major bleeding compared with heparin monotherapy. Funding Chinese Society of Cardiology Foundation (CSCF2019A01), and a research grant from Jiangsu Hengrui Pharmaceuticals.

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Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries.

Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. Funding National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.

Pubmed   Journal   ReadQx   PMC

Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT): a randomised, double-blind, placebo-controlled trial.

Interpretation H pylori eradication protects against aspirin-associated peptic ulcer bleeding, but this might not be sustained in the long term. Funding National Institute for Health and Care Research Health Technology Assessment.

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Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke (ENCHANTED2/MT): a multicentre, open-label, blinded-endpoint, randomised controlled trial.

Interpretation Intensive control of systolic blood pressure to lower than 120 mm Hg should be avoided to prevent compromising the functional recovery of patients who have received endovascular thrombectomy for acute ischaemic stroke due to intracranial large-vessel occlusion. Funding The Shanghai Hospital Development Center; National Health and Medical Research Council of Australia; Medical Research Futures Fund of Australia; China Stroke Prevention; Shanghai Changhai Hospital, Science and Technology Commission of Shanghai Municipality; Takeda China; Hasten Biopharmaceutic; Genesis Medtech; Penumbra.

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Intermediate-dose versus low-dose low-molecular-weight heparin in pregnant and post-partum women with a history of venous thromboembolism (Highlow study): an open-label, multicentre, randomised, controlled trial.

These results indicate that low-dose low-molecular-weight heparin for thromboprophylaxis during pregnancy is the appropriate dose for the prevention of pregnancy-related recurrent venous thromboembolism. Funding French Ministry of Health, Health Research Board Ireland, GSK/Aspen, and Pfizer.

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Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): an investigator-initiated, prospective, randomised, open-label, blinded-endpoint trial.

Interpretation For a broad range of patients with heart failure, reduced left ventricular ejection fraction and iron deficiency, intravenous ferric derisomaltose administration was associated with a lower risk of hospital admissions for heart failure and cardiovascular death, further supporting the benefit of iron repletion in this population. Funding British Heart Foundation and Pharmacosmos.

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LY3437943, a novel triple GIP, GLP-1, and glucagon receptor agonist in people with type 2 diabetes: a phase 1b, multicentre, double-blind, placebo-controlled, randomised, multiple-ascending dose trial.

This finding, together with the pharmacodynamic findings of robust reductions in glucose and bodyweight, provides support for phase 2 development. Funding Eli Lilly and Company.

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Personalised cooler dialysate for patients receiving maintenance haemodialysis (MyTEMP): a pragmatic, cluster-randomised trial.

The rising popularity of cooler dialysate is called into question by this study, and the risks and benefits of cooler dialysate in some patient populations should be clarified in future trials. Funding Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Renal Network, Ontario Strategy for Patient-Oriented Research Support Unit, Dialysis Clinic, Inc., ICES (formerly known as the Institute for Clinical Evaluative Sciences), Lawson Health Research Institute, and Western University.

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Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a pragmatic, cluster-randomised trial in seven low-income and middle-income countries.

We suggest that it should be widely implemented into surgical practice around the world. Funding National Institute for Health Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, Mölnlycke Healthcare.

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N Engl J Med

Defibrillation Strategies for Refractory Ventricular Fibrillation.

Among patients with refractory ventricular fibrillation, survival to hospital discharge occurred more frequently among those who received DSED or VC defibrillation than among those who received standard defibrillation. (Funded by the Heart and Stroke Foundation of Canada; DOSE VF ClinicalTrials.gov number, NCT04080986.).

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Duration of Device-Based Fever Prevention after Cardiac Arrest.

Active device-based fever prevention for 36 or 72 hours after cardiac arrest did not result in significantly different percentages of patients dying or having severe disability or coma. (Funded by the Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.).

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Efficacy and Safety of Bepirovirsen in Chronic Hepatitis B Infection.

In this phase 2b trial, bepirovirsen at a dose of 300 mg per week for 24 weeks resulted in sustained HBsAg and HBV DNA loss in 9 to 10% of participants with chronic HBV infection. Larger and longer trials are required to assess the efficacy and safety of bepirovirsen. (Funded by GSK; B-Clear ClinicalTrials.gov number, NCT04449029.).

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Empagliflozin in Patients with Chronic Kidney Disease.

Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo. (Funded by Boehringer Ingelheim and others; EMPA-KIDNEY ClinicalTrials.gov number, NCT03594110; EudraCT number, 2017-002971-24.).

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In Utero Enzyme-Replacement Therapy for Infantile-Onset Pompe's Disease.

The family history was positive for infantile-onset Pompe's disease with cardiomyopathy in two previously affected deceased siblings. After receiving in utero ERT and standard postnatal therapy, the current patient had normal cardiac and age-appropriate motor function postnatally, was meeting developmental milestones, had normal biomarker levels, and was feeding and growing well at 13 months of age.

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Lifting Universal Masking in Schools - Covid-19 Incidence among Students and Staff.

Among school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.

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Methylprednisolone for Heart Surgery in Infants - A Randomized, Controlled Trial.

Among infants undergoing surgery with cardiopulmonary bypass, prophylactic use of methylprednisolone did not significantly reduce the likelihood of a worse outcome in an adjusted analysis and was associated with postoperative development of hyperglycemia warranting insulin in a higher percentage of infants than placebo. (Funded by the National Center for Advancing Translational Sciences and others; STRESS ClinicalTrials.gov number, NCT03229538.).

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Phase 2 Trial of Baxdrostat for Treatment-Resistant Hypertension.

Patients with treatment-resistant hypertension who received baxdrostat had dose-related reductions in blood pressure. (Funded by CinCor Pharma; BrigHTN ClinicalTrials.gov number, NCT04519658.).

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Progression of Atrial Fibrillation after Cryoablation or Drug Therapy.

Initial treatment of paroxysmal atrial fibrillation with catheter cryoballoon ablation was associated with a lower incidence of persistent atrial fibrillation or recurrent atrial tachyarrhythmia over 3 years of follow-up than initial use of antiarrhythmic drugs. (Funded by the Cardiac Arrhythmia Network of Canada and others; EARLY-AF ClinicalTrials.gov number, NCT02825979.).

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Small Interfering RNA to Reduce Lipoprotein(a) in Cardiovascular Disease.

Olpasiran therapy significantly reduced lipoprotein(a) concentrations in patients with established atherosclerotic cardiovascular disease. Longer and larger trials will be necessary to determine the effect of olpasiran therapy on cardiovascular disease. (Funded by Amgen; OCEAN[a]-DOSE ClinicalTrials.gov number, NCT04270760.).

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Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia.

Among patients with CLTI who had an adequate great saphenous vein for surgical revascularization (cohort 1), the incidence of a major adverse limb event or death was significantly lower in the surgical group than in the endovascular group. Among the patients who lacked an adequate saphenous vein conduit (cohort 2), the outcomes in the two groups were similar. (Funded by the National Heart, Lung, and Blood Institute; BEST-CLI ClinicalTrials.gov number, NCT02060630.).

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Trial of an Intervention to Improve Acute Heart Failure Outcomes.

Among patients with acute heart failure who were seeking emergency care, the use of a hospital-based strategy to support clinical decision making and rapid follow-up led to a lower risk of the composite of death from any cause or hospitalization for cardiovascular causes within 30 days than usual care. (Funded by the Ontario SPOR Support Unit and others; COACH ClinicalTrials.gov number, NCT02674438.).

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Triglyceride Lowering with Pemafibrate to Reduce Cardiovascular Risk.

Among patients with type 2 diabetes, mild-to-moderate hypertriglyceridemia, and low HDL and LDL cholesterol levels, the incidence of cardiovascular events was not lower among those who received pemafibrate than among those who received placebo, although pemafibrate lowered triglyceride, VLDL cholesterol, remnant cholesterol, and apolipoprotein C-III levels. (Funded by the Kowa Research Institute; PROMINENT ClinicalTrials.gov number, NCT03071692.).

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Reviews&Editorials

Plenty of the editorials are available as full text through the publisher website using the provided link

Ann Intern Med

Characteristics of High-Need, High-Cost Patients : A "Best-Fit" Framework Synthesis.

A combination of characteristics can be useful for identifying HNHC patients. Because of the complexity of their conditions and circumstances, improving their quality of care will likely also require an individualized assessment of care needs and availability of support services. Primary funding source Agency for Healthcare Research and Quality. (PROSPERO CRD42020161179).

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Preoperative Evaluation for Noncardiac Surgery.

This update reaffirms much of the information in the previous version and provides new information that has accumulated since then. The goal of preoperative assessment is to identify the risk for postoperative complications so health care teams can more fully understand how to implement strategies to mitigate risks before and after the operation.

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Lancet

Offline: Resist, imagine, enact-an antidote to global vanity.

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Type 2 diabetes.

Despite advances, substantial barriers to changing the course of the epidemic remain. This Seminar offers a clinically focused review of the recent developments in type 2 diabetes care including controversies and future directions.

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N Engl J Med

A Modern Therapy for an Ancient Disease.

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Audio Interview: Masking and Covid-19.

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Clean Cooking Fuels to Improve Health during Pregnancy.

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Defibrillation after Cardiac Arrest - Is It Time to Change Practice?

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Prenatal Enzyme-Replacement Therapy.

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The Fibrates Story - A Tepid End to a PROMINENT Drug.

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Universal Masking Policies in Schools and Mitigating the Inequitable Costs of Covid-19.

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Miscellaneous

misc publications eg case reports, tools of the trade, images of the month, etc…

Ann Intern Med

Annals Graphic Medicine - The Bleeding Heart.

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Annals Video Summary - Identifying High-Need, High-Cost Patients: A Framework Synthesis.

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Identifying High-Need, High-Cost Patients: A Real-World Perspective.

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Lancet

Aspirin and Helicobacter pylori interaction.

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Bacterial infection possibly causing autoimmunity: Tropheryma whipplei and membranous nephropathy.

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Bivalirudin in patients with ST-segment elevation myocardial infarction.

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Blood pressure goals after mechanical thrombectomy: a moving target.

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Changing gloves and switching instruments to decrease surgical site infection in abdominal surgery.

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Climate change, health, and discrimination: action towards racial justice.

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COVID-19 and other adult vaccines can drive global disease prevention.

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Delivering evidence to prevent recurrent venous thromboembolism in pregnancy.

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Evaluating the results of MyTEMP, a cluster randomised trial of lower temperature haemodialysis: the end of a cool idea?

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Implementation, not hesitation, for SGLT2 inhibition as foundational therapy for chronic kidney disease.

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Intravenous iron passes another endurance test in heart failure.

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Iranian medics at the forefront of protests.

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Language changes for Indian medical education.

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The crisis of maternal and child health in Afghanistan.

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The NIH Climate Change and Health Initiative and Strategic Framework: addressing the threat of climate change to health.

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Ukraine health care prepares for nuclear disaster.

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N Engl J Med

Avoiding Contrast-Enhanced Imaging to Prevent Contrast-Induced Acute Kidney Injury.

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Case 34-2022: A 57-Year-Old Woman with Covid-19 and Delusions.

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Cognitive Deficits in Long Covid-19.

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Diagnostic Distress - An Element of Blank.

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Long-Acting Injectable Antiretrovirals in Incarcerated Populations - Challenges and Opportunities.

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Pyoderma Gangrenosum.

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Seat-Belt Sign and Seat-Belt Aorta.

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Letters&Replies

Letters to the editors and authors’ replies

Lancet

Fixing US public health infrastructure for 1% of annual military budget.

Pubmed   Journal   ReadQx   PMC

India at 75 years: improving tribal health for self-reliance.

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Latin America's new beginnings?

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Latin America needs evidence-supported health-care policies.

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Political impartiality of medical journals is needed.

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Reactions to START:REACTS - Authors' reply.

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Reactions to START:REACTS.

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Solving endgame problems for 1·4 billion people in India.

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Where is the new beginning for Latin America?

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N Engl J Med

Removal of Small, Asymptomatic Kidney Stones and Relapse.

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Removal of Small, Asymptomatic Kidney Stones and Relapse.

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Removal of Small, Asymptomatic Kidney Stones and Relapse.

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Removal of Small, Asymptomatic Kidney Stones and Relapse. Reply.

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Six-Month Follow-up after a Fourth BNT162b2 Vaccine Dose.

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